Loading...
HomeMy WebLinkAboutSoil Suitability Assessment Sheets ' . ' �;r %; C�� �� r °� ;sU � ��� 1 5 2�u? HEALTI-i DFf'7, fOftM il - SOIL I:YALUATOR FOILM Page 1 of 3 No. Date: ,�lzyl�Z Coinmonwenllh of Massachusetls ��emo�n+ , Messachusetts .�oi[ Suilu�ii�lv As,seF,���Ec�t�,f�r � - i[e Se���nge Di�osal Performecl Dy: G.N��..W�c��..,�- En�r(Cnvc ����cte,,..y , w�• • bale: �c�z.y��c. WilnesseJ Dy: Amy �o�.,l,k�� ,- C�e:m�„m I�yTl1._ [7cYtN[T+tiw'f' . ._ . . _ .�...... _......._ .... ... Lm�b Atlal a �w O.R�'�Nurc. \ � �I II CA{�M�� �O([.� ��`� � nlN���.�N B�13AQA �✓UNO�Q� 5• Ynero,o�na, nnA '"'"""` ' 9� (J>ern�.J `(�e�t �c � S � ypQ.rv,.,�,a , M/� ew Constructlon ❑ Repalr �1 O(IZce Rev ew PubHshed Soil Survey Aveilable: No ❑ Yes � Yeer Published' ��`� - . Publicelion Scele ����•�rw so�� Me,, u���� �aA.. .. .__. . �OGJlZ �1..i�W\TWJ�...� SJg+IQANf��. Dreinege Clasr Gc�'����=......... Soil Limilations � - Surficiel Geologic Report Availeble: No ❑ .Yes � Year Published �`���D Publiceiion Scale �����O�n�^' Geologic Meterial (Mep Unil) �h� - . L.andfom� _......._1-1�¢�^!'.�:�a..._O.,rwa��� �v> a 1.'A-c�,s�rs.. _ .. .... . flood Insurance Rate Mep: Afwve SUO year tlooJ boundery No ❑Yes � Wilhin 500 yeer Oood bow�dery No �Yes � Will�in 100 ycar OooJ l�undery No �Ybe ❑ Wetlend Aree: N�lionel WetlenJ Invenlory Mep pnep uni�) ..............................................................------�—�• � Wellands Conservency Prognm Mep (mep unil) _...................................._.._............._.... Current W�ler Resource ConJllions (USOS): Monlh --._-.--. (tuige :AboveNonnel ❑Normal ❑DelowNomial ❑ 011Kr Refaa�as Reviewaf: � av unovm m�ni.umm • . � FOftM 11 - SOQ. EVALUATOR FORM Page 2 of 3 Location Address or Lot No. `4� CAfm��J �be�. �GAD On-site Review Deep Hole Number �� Dete: ..�Q.`Z�`ft"Z Tlme: Z" Weether sv�+�,...+ Locatlon (IdenUly on site planl - Lend Use ..�...,,R.€:�t0�,?itln. Slope (%1 0-3�� Surfece Stones �"'E v4s�a�F. VepeteUon ,...,GQqrr,,_ M�v.E . .. . . .. .... . . ... ._.. .. .... . ... ._..... . . Land/orm ...,.o".Ltit±1`.`�51 Wu,-' . . . . . . .. .... ._ . . .._,. . . Posltlon on lendecape (eketch on the backl Distancee from: Open Weler Body y��`' leet Drelnage way �7Z' leet Poselble Wet Area '���� leet Property Llne >�� leet Drinking Weter Well 7�ac> leet Other DEEP OBSERVATION HOLE LOG� Depth from Soll Harl=on SoIUSDAIr� M'u�e'll� Malt I'n0 IStiueture. Stons�,Boutder�, Contl�tency, % Surl�ce Ilncheq ( Onwl) n '� �,oAm..� 3 � . . Q - l0 � SfanJp {a�LQ. �z f,lc..� ��na.r, �...I 1�.�3 �� �� lU - 20 13 I.ar.m� �J [- . 5nn�p 7,�yQ (V IJo�..�� {'Q.ln0i6 N �� ?P -13 L Y�1 Eo,��h Lo �. F1Nti �UNe.�'�b' 1-�0;,� �E . SiWD . i hr�nt Mtlhid IW�O�eI C�-�inf�(+�- ��.�wAS�� �MO�O�1 '��b Mutl�m Orardwna: Strdln0 W�ur In Ur Nole: n�/� Wwpkq hom Pft F�a: �(E 6tlnrlM SwonM Mph f3rand Wmr: ^��A � � oe�traovm touH-tvnm . l�(71N�1 12 - PLRCOLA'1'l�N 'CL5'C Locellon AdJrass ur Lut No. `� � �T��^� `�2i� �'�� COMMONWL=AL"I�I-I 01= MASSACI-IUSL-I""fS `��,�„n{ , Massacliuselts ,� 1'e�•culi�li�u '1.'esl* L�ele: ... .. �o�z`l��z 'I lino:. .Z�.= . .. . .. . . Q�aetvoUvn .1 lole /! # i Depth of Perc R,p � �" Start Pre-soalc p : �� . @nd Pre-soolc �q" L Iv:Zn l�ime et�12" • Tfine et 9" • Time et 0" Ti�iie (g��_a��) flele Mln./Ineh • Mlnitnum �f 1 ��ercoleUon lest nivat Ue perlunnaJ In bulh the priniary eree AND reserve oreo. � � ' ��'•' .., .. 511e Passed � Slle ralled � ........................... ............................__............_......_ . re�ror�„aa g�: G��� w,�k,,:-� . . WIllleeeed ny: l�m� ��� I-w,�G cvmments: ..._._�._____•._,.........w.,....._..._..�....,.,............;.._....,._..,.:.;,....�__......,..,...__...�,,...�......,..��M,..........._..,_,.,.. � uer ru•rnuvrL Punnl-�:�onrs � , ' � � • . ��OItl1t i l - SU11, LVALUA'f011 I�oi�ni Pa�;c J uf 3 Loailiou Address or Lol No. `fl �P�-ra�rayne�� 1Z�o Deleri�ciicaliuic J'ur SCfl3'O1lU� IIL�JI !�1'ciler '1'uGle N'A- No w�n.� c�vea��.,r-�¢EO �r-> T�7cito�.E . . IVIB��IOd US9d: CI L)epll� o�servoJ slnn�in� In u�sUivuliun liul� _ _. incl�os ' ❑ DopU� woe��i�i� liuni sicle uf uusaivaUun (iulo iiiches ' U beplli lu suil n�ulU�s _ . incl�os U Gruuncl woler e�juslinenl ................... faol � hidex Well Nuniber ................ Iloadii�y Uulo ................. Indc�x well level .... ._ ,nd��g��»e„� ra���r ...._........... nd)usied yr.�u�,� wolor level ._............................._..........,... Deulh of Neturallv Occurriny Pervfous Molorlal Does al leasl four feet of naturally occurring pervious inelerlol ekist iii all ereas observo� tl�rouyl�out tlia uruo ��ru��usdd tur llio soil obsur��Uvn sysleiri7 �I� If not, what is the deplh of r�ulurolly occurrin� pervious malerial7 Certiflcadon , I cerlify thol on �u.1�tKq �dotel 1 have �essed llie soil evaluelor exeminalion approved �y the beparUnenl of Cnvironmenlel Proleclion ond thet the above analysis wes perfonned by ine consislvnt with the requlred troihh,y, experlise and experfence described in 310 CMfi 1 G.017. _ Signalure ��-�t/V�` Dole �U L l . . � in;r nrrnoc�u ru�mi• i:ionrs